The Nineteenth Century: Gottleib Burckhardt

The first report of what we would recognise as ‘psychosurgery’ was made by Gottleib Burckhardt, a Swiss psychiatrist, in 1891 (Burckhardt, 1891). In a paper of 85 pages which included detailed case histories, he reported on six patients, described as “demented” and “aggressive” that underwent ‘temporal topectomy’ in the Prefarger Asylum in Switzerland, commencing on the 29 December 1888. His subjects were deluded, hallucinated, and frequently violent, and probably suffered from schizophrenia (Berrios, 1997). His aim was to sever the nerve fibres connecting the frontal lobes and the rest of the brain. His results were mixed: one patient developed epilepsy and died five days postoperatively; a further patient developed epilepsy; and one patient suffered permanent motor weakness. One patient improved; two patients were reported as being quieter; and the other two patients showed no change. He presented his findings at the Berlin International Medical Congress in 1889, but his actions met with a mixture of quiet disregard and open ridicule. Despite previously publishing a book on the physiological basis of mental illness, he never wrote further on the subject.

The debate about surgical approaches to insanity continued, but the consensus view among most psychiatrists was that such interventions could not be justified. One of the most vocal critics was the US psychiatrist, Abraham Brill, who despite publishing criticisms of neurosurgical treatments, was forced to accept that some patients may benefit when no other treatment had succeeded.

The poor outcomes from neurosurgery for most patients with schizophrenia undoubtedly contributed to the scepticism among the medical community. Another factor in the resistance to psychosurgery was probably the development of psychoanalysis by Sigmund Freud in the last decade of the 19th Century. His ideas and writings greatly influenced practice throughout Europe on both the aetiology and treatment of most mental disorders, and it could be argued that the biological approach to mental illness of the last half of the 19th Century was only resurrected in the latter half of the 20th Century.

Despite a reluctance to employ surgical interventions for mental disorder at the end of the 19th Century, intracranial surgery for tumours, epileptogenic foci, and brain injuries (often as a result of the First World War) continued, building the surgical base from which people like Egas Moniz and Walter Freeman would step.